Cost Analysis of Medical versus Surgical Management of Glaucoma in Nigeria

Purpose: To analyze the cost of glaucoma medical therapy and compare it with that of surgical management in Nigeria. Methods: The cost of glaucoma drugs and that of surgical therapy in patients who attended the eye clinic of the University of Benin Teaching Hospital, Benin City, Nigeria, between December 2002 and November 2008 were calculated over a 3 year period of follow-up. Costs of medical and surgical therapy were compared based on November 2008 estimates. Results: One hundred and eight patients met the inclusion criteria of the study, of which, 90 patients (83.33%) received medical therapy and 18 patients (16.67%) underwent surgery. The most expensive drugs were the prostaglandin analogues, travoprost (Travatan) and latanoprost (Xalatan). The least expensive topical drugs were beta-blockers and miotics. The mean annual cost of medical treatment was US$273.47΁174.42 (range,$41.54 to $729.23) while the mean annual cost of surgical treatment was US$ 283.78΁202.95 (range, $61.33 to$592.63). There was no significant difference between the mean costs of medical and surgical therapy over the 3-year period (P = 0.37). Older age (P = 0.02) and advanced glaucoma (P < 0.001) were associated with higher costs of therapy. Conclusion: The cost of medical therapy was comparable to that of surgical therapy for glaucoma in Nigeria over a 3-year period

Micro-trephination Glaucoma Surgery In Nigerians: 10 Years Outcome

The aim of this study was to show the effectiveness of microtrephination glaucoma surgery in Nigerians followed up for up to 10 years. Eight eyes of 5 Nigerian patients who had microtrephination glaucoma surgery at DDS Eye Surgery, Benin City and the University of Benin Teaching Hospital Benin City were followed up for at least 10 years. The visual acuity, cup disc ratio and intraocular pressures were monitored in each eye. Intraocular pressure was measured by applanation tonometry in all cases. Two eyes (25%) had adequate intraocular pressure control and did not require additional medications after 10 years. The remaining 6 eyes (75%) did not have satisfactory intraocular pressure control and needed additional antiglaucoma medication. Micro-trephination appears to be unsatisfactory for effective control of intra-ocular pressure in Nigerian eyes. However the great potential of microtrephination making glaucoma surgery affordable and available to Nigerians and other developing countries may still be realizable. What may be required is to determine the appropriate diameter of the trephine that strikes adequate balance between preventing hypotony and obliteration

Pharmacological strategies for the management of cancer pain in developing countries

Pain associated with cancer is often under treated especially in the developing countries where there are problems of poor economy, poor purchasing power of the citizens, absence of effective national health insurance schemes, poor manpower, fake adulterated and expired drugs, poor drug storage conditions; adverse temperature conditions combined with poor power supply which may affect drug efficacy. There is also poor understanding of the physiopharmacology of cancer pain management by health care providers. Assessment of the severity of the pain by location, oncological type, as well as psychosocial, emotional and environmental factors are necessary. The pain often occurs from malignancy, from procedures done to diagnose, stage and treat the malignancy, and from the toxicities of therapy used in treating the cancer. The first priority of treatment is to control pain rapidly and completely, as judged by the patient. The second priority is to prevent recurrence of pain. Analgesic drugs are given ¿by the ladder,¿ ¿by the clock¿ and ¿by the appropriate route¿ using the analgesic ladder guideline proposed by the World Health Organization (WHO). The pharmacological aspects of various drugs used in the management of cancer pain are discussed

Pharmacological strategies for the management of cancer pain in developing countries

Pain associated with cancer is often under treated especially in the developing countries where there are problems of poor economy, poor purchasing power of the citizens, absence of effective national health insurance schemes, poor manpower, fake adulterated and expired drugs, poor drug storage conditions; adverse temperature conditions combined with poor power supply which may affect drug efficacy. There is also poor understanding of the physiopharmacology of cancer pain management by health care providers. Assessment of the severity of the pain by location, oncological type, as well as psychosocial, emotional and environmental factors are necessary. The pain often occurs from malignancy, from procedures done to diagnose, stage and treat the malignancy, and from the toxicities of therapy used in treating the cancer. The first priority of treatment is to control pain rapidly and completely, as judged by the patient. The second priority is to prevent recurrence of pain. Analgesic drugs are given ¿by the ladder,¿ ¿by the clock¿ and ¿by the appropriate route¿ using the analgesic ladder guideline proposed by the World Health Organization (WHO). The pharmacological aspects of various drugs used in the management of cancer pain are discussed

Cumplimiento con los nuevos medicamentos antiglaucoma en Benin City - (Nigeria).

Objetivo: Determinar la tasa de cumplimiento, las razones de su fallo y los factores que afectan al cumplimiento con los nuevos medicamentos para el tratamiento del glaucoma. Métodos: Se siguió durante un tiempo mínimo de 3 meses y máximo de 9 a 56 pacientes nuevos a tratamiento con los medicamentos nuevos para glaucoma primario de ángulo abierto. Se registraron el número de dosis perdidas por semana así como las razones por las que se perdieron. Se comparó a los pacientes cumplidores y no cumplidores en relación al tratamiento prescrito y sus características personales. Resultados: los medicamentos más prescritos fueron dorzolamida, brinzolamida, latanoprost, apraclonidina y travoprost. La tasa de incumplimiento fue del 66,1%. Las principales causas del incumplimiento fueron los efectos adversos (36,6%), escasez de medicamentos (22%) y alto coste de medicamentos (12,2%). El conocimiento sobre el glaucoma estaba significativamente asociado con el buen cumplimiento (p>0,01). Conclusión: El cumplimiento con los nuevos medicamentos para el tratamiento del glaucoma es muy pobre. Se requiere educación sanitaria y la provisión de medicamentos asequibles, accesibles y apropiados